Vol 22, No 2 (2017)
Research paper
Published online: 2017-03-01

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Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Alejandra Méndez Romero1, Fatma Keskin-Cambay1, Rob M. van Os2, Joost J. Nuyttens1, Ben J.M. Heijmen1, Jan N.M. IJzermans3, Cornelis Verhoef3
DOI: 10.1016/j.rpor.2016.10.003
Rep Pract Oncol Radiother 2017;22(2):126-131.

Abstract

Aim

To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity.

Materials and methods

A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6[[ce:hsp sp="0.25"/]]cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5[[ce:hsp sp="0.25"/]]Gy or 16.75[[ce:hsp sp="0.25"/]]Gy prescribed at the 65–67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0.

Results

A total of 40 patients with 55 colorectal liver metastases were included in this study. We delivered 37.5[[ce:hsp sp="0.25"/]]Gy to 32 lesions, and 50.25[[ce:hsp sp="0.25"/]]Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group.

Conclusions

SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.

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